EVIDENCE-BASED PRACTICE INTEGRATION ACROSS HAWAI`I S ACADEMIC INSTITUTIONS

Transcription

1 EVIDENCE-BASED PRACTICE INTEGRATION ACROSS HAWAI`I S ACADEMIC INSTITUTIONS Katherine Finn Davis, PhD, APRN, CPNP Associate Director of Evidence Based Practice Hawai`i State Center for Nursing kfdavis@hawaii.edu Carolyn Dennison, MA, MLIS, AHIP Science & Technology Librarian University of Hawai`i at Manoa cdenniso@hawaii.edu

2 Objectives Describe the creation of a state-wide evidence-based program to integrate EBP into undergraduate curricula Delineate specific approaches identified by educators to facilitate academic integration

3 DRIVERS FOR CURRICULUM INTEGRATION OF EBP Clinical & Academic

4 Clinical Drivers for EBP Federal agencies & bodies AHRQ, DHHS, CMMS, NIH Accreditation & awards Joint Commission: Standards and National Patient Safety Goals Beacon Award, Magnet Recognition, etc. Other organizations Quality and Safety Education in Nursing (QSEN) Institute National Academy of Medicine Repeatedly shown to improve outcomes

5 Academic Drivers for EBP American Association of Colleges of Nursing (AACN) Baccalaureate Essentials III (2008): Scholarship for EBP Master s Essentials IV (2011): Translating and integrating scholarship into practice DNP Essentials III (2006): Clinical scholarship & analytical methods for EBP Employers QSEN published competencies: Pre-licensure and Graduate

6 Bottom Line EBP is no longer a luxury But a necessity With increasing accountability And possible liability in the future Academicians are responsible to ensure graduates are competent in EBP So, what s an academician to do? Become a competent practitioner of EBP Systematically integrate EBP content into curriculum

7 Become a Competent Practitioner of EBP Necessary skills to perform evidence-based practice

8 Basic EBP Skills Differentiate EBP from research and quality improvement Identify a problem & write a PICO statement Develop literature search skills: Search selected databases and resources and adjust search strategies Critique the literature Know different grading criteria & corresponding levels of evidence Synthesize the literature Distinguish from an annotated bibliography or literature review Use Excel to organize body of evidence; use of subtopics Make practice recommendations Define & discuss translation science Implementation strategies Evaluation strategies

9 Systematically Integrate EBP Content into Curriculum Using an EBP model

10 Conceptual Model for EBP The Iowa Model

11 Pedagogical Strategies for EBP 1. Triggers Drivers for EBP: Clinical and academic Sporadic EBP content Some students received none; others received more 2. Form a Team EBP Content Expert Librarian Course Coordinators

12 3. Assemble Relevant Research PubMed (Teaching EBP AND Nurs) 120 Articles Limited to: Humans Published in past 5 years Research & Systematic Reviews 47 Articles Teaching Strategies 9 Articles Screened 5 Articles Librarian Search 9 Articles 1 Overlapped 8 Articles Other literature 9 Articles 3 Textbooks

13 4. Critique & Synthesize Research 9 of 22 articles were about different strategies to teach critiquing skills (2 Level III, 7 Level VI) Courses and workshops demonstrated improvements in knowledge, attitudes, & skills of undergraduate nursing students (Davidson, 2016, Level III; Zhang, 2012; Level III) Student-staff-faculty partnerships were utilized to facilitate learning about EBP (Balakas, 2010; Level VI; Moch 2010, Level VI; Schreiner, 2015, Level VI)

14 Non-research based General Pedagogical Strategies Small doses, over time Simple to complex Integrate into every course Problem-based learning Emphasize relevance to Practice Clinical problems

15 Example Learning Activities Gaming platforms Appraising evidence game Debates Case studies EBP rounds Journal clubs One burning question Building blocks Grade literature searches

16 5. Is There a Sufficient Evidence Base? Is it enough to make practice changes? Quality, quantity, & consistency of findings Feasibility Relevance of research findings for teaching Individual student & faculty circumstances, values, preferences Risk/benefit ratio

17 5. Pilot the Practice Change Three-day statewide EBP Educator workshop 50 nurse educators Seven of the state s nine schools of nursing were represented Curriculum design Steps of Iowa Model One step each semester Pedagogy Spiraled/Leveled/Folded Teaching strategies

18 6. Institute the Practice Change University of Hawai`i at Mānoa Baccalaureate Program Iowa Model 7 steps, 9 classes over 6 semesters Courses mapped to AACN Essentials for Baccalaureate Education, steps of EBP, & related information literacy skills Met with lead faculty of each course Refined content for each course Packaged course materials Assisted with lectures, as needed Resources shared amongst all faculty Began implementation with Fall 2016 Sophomores

19 Course Sem Bacc Essentials III Iowa Model Phase N211: Professionalism Fall AOC 1 N210: Health Promotion Across Lifespan EBP Content (spiral/level/fold throughout) Curriculum map Introduce EBP & Information Literacy Competencies; Differentiate PI, EBP, Research (defining terms) Fall 1 EBP & The Iowa Model N220: Med-Surg I Spring 2 Triggers, Priorities, & Teams N320: OB/Peds (WI) Fall 2 PICO & Purpose Statements N360: Med-SurgII Spring 3 Assemble the Literature Information Literacy Search Terms, Credibility of Resources, National Guidelines Summarize an Article (250 words) Levels of Evidence, Finding Filtered Information MESH Terms, Write Annotated Bibliography Search Med-Surg Topic, Write Annotated Bibliography Course Packaging Sept Oct Jan Jan Jan N363: Research (ETH) Spring 4 Critique & Synthesize Literature Retrieve & Appraise Unfiltered Literature, Group by Design, Synthesize Jan N450: Community (OC, WI) Fall 5 Piloting the Practice Change (didactic - module); PICO & Critique/Synthesize Literature for Public Health Issue Retrieve Public Health Resources Feb N465: Psych/Mental Health Fall 6 Institute the Practice Change (didactic - module); PICO & Critique/Synthesize Literature for Mental Health Issue Retrieve, Appraise, & Synthesize. Recommend Practice Change Mar N460: Complex Nursing & Leadership (WI) Spring 7 Monitor and Analyze Structure, Process, and Outcome Data (didactic-module) Retrieve, Appraise, & Synthesize. Recommend Practice Change Apr

20 7. Evaluate the Practice Change Multiple requests from across state for another workshop EBP Champions Representatives from each school meet quarterly Plan to serve as faculty at next Educators Workshop Other schools have also begun to integrate EBP into their curriculum (UG and Graduate)

21 Conclusion: EBP is not a luxury, it is a necessity for all nurses EBP is now integrated into clinical and academic quality drivers Academicians need to gain knowledge and skills to be effective educators of EBP Integrating the EBP process into curriculum is a feasible approach to educate nursing students Statewide integration of EBP at the educator and curriculum level is possible (and still a work in progress!)

22 References Balakas, K., & Sparks, L. (2010). Teaching research and evidence-based practice using a service-learning approach. Journal of Nursing Education, 49(12), doi: / Davidson, S. J., & Candy, L. (2016). Teaching EBP Using Game-Based Learning: Improving the Student Experience. Worldviews on Evidence-Based Nursing, 13(4), doi: /wvn Moch, S. D., & Cronje, R. J. (2010). Part II. Empowering grassroots evidence-based practice: a curricular model to foster undergraduate student-enabled practice change. Journal of Professional Nursing: Official Journal of the American Association of Colleges of Nursing, 26(1), doi: /j.profnurs Moch, S. D., Cronje, R. J., & Branson, J. (2010). Part 1. Undergraduate nursing evidence-based practice education: envisioning the role of students. Journal of Professional Nursing: Official Journal of the American Association of Colleges of Nursing, 26(1), doi: /j.profnurs Schreiner, M., Kudrna, B., & Kenney, C. (2015). How undergraduate students can contribute to EBP. Nursing Management, 46(9), doi: /01.NUMA b5 Zhang, Q., Zeng, T., Chen, Y., & Li, X. (2012). Assisting undergraduate nursing students to learn evidence-based practice through self-directed learning and workshop strategies during clinical practicum. Nurse Education Today, 32(5), doi: /j.nedt

23 Laura Reichhardt, MS, APRN, NP-C Amy Ono Debra Mark, PhD, RN, FAAN Marita Titler, PhD, RN, FAAN